Introduction

Here you’ll find answers to some of the questions that parents often have about this condition. Additional resources are listed
at the bottom of the page. Diagnosis and management information can be found in the Constipation module, which is written for primary care clinicians but also may be of help to parents and family members.

What is constipation and what causes it?

Constipation is a pattern of delayed, painful, or hard bowel movements. Most people have an occasional hard poop, but if this
happens frequently, it can cause problems. Hard stools and pain/discomfort associated with passing them may cause children
to “retain” stools. These retained stools get even harder and fresh stool may start leaking around these hard stools, causing
“accidents” or encopresis.

What are the symptoms of constipation?

Constipation can cause pain, a swollen belly, loss of appetite, gastro-esophageal reflux (heartburn), and even loss of ability
to control the bowel movements. Pain from constipation in kids is usually crampy, sharp, or achy pain around the belly button
or the sides of the belly. Usually this pain occurs while your child is awake and is worse after eating or with exercise.
Although the cramps or aches may keep children from falling asleep, the pain does not usually wake them from sleep. Sometimes
a child can accumulate so much poop in their rectum that it keeps the anus open, resulting in leaking, which can appear to
be diarrhea or soiling. Bulky hard poop can make small rips in the anus that leave spots of blood when the child wipes.

How is it diagnosed?

The primary care clinician may use specific criteria to diagnose constipation. Constipation generally includes more than one
symptom including two or fewer bowel movements in a week, leaking stool once a week, holding back bowel movements, hard or
painful bowel movements, or large stools that block the toilet.

What is the prognosis?

Most children with functional constipation require prolonged treatment. In one study, after intensive initial medical and
behavioral treatment, 60% of children were treated successfully after 1 year with follow-up care and 80% of children were
treated successfully by 8 years of follow-up care. One-third of the children needing follow-up beyond puberty continued to
have severe complaints of constipation. [van: 2003]

What is the risk for other family members or future babies?

There are some conditions that lead to an increased risk of having constipation, such as diabetes, hypothyroidism, celiac
disease, and specific protein allergies, although most children have constipation, not associated with other medical conditions.
Families can ask their primary care clinician about the cause of their child's constipation and the risk of constipation in
future children.

What treatments/therapies/medications are recommended or available?

Parents can help prevent constipation by making sure that the child gets adequate fluids and fiber in the diet, exercise,
appropriate positioning, and regular, unrushed toileting time after meals. These strategies are also good first steps to treat
mild constipation as well.

In addition to fluids, diet, and lifestyle changes, the daily use of medications over a prolonged period may be necessary
to keep some children regular; this is called “maintenance therapy.” In children, these medications are various kinds of laxatives.
The child’s primary care clinician in the medical home can work with the family to develop a tailored plan for the child’s
constipation if needed.

How will my child and our family be impacted?

Changes in dietary, eating, and exercise habits are part of the routine needed to reduce constipation and can be supported
by the whole family adopting the changes.

When should I seek urgent medical attention for my child?

Vomiting or dehydration related to the constipation or bowel problem

Swollen, firm abdomen that is painful to the touch or associated with fever (seek immediate medical attention)

Pain doesn’t go away or is getting worse

Blood is in or around the stool (can be non-urgent, but check with your primary care clinician if this is new)

Stool is not able to be passed despite appropriate medications

An enema has not come back out

Are there medications that can help my child's constipation?

A typical bowel program will first clean out the large intestine and then continue to keep the stool mushy and easy to push
out. This is the main mode of constipation treatment. The goal of the bowel management program is to produce 1-2 mushy, easy-to-pass,
painless poops every day. It is important for the treatment to continue for several months, if not longer. If your child has
any problems with their prescribed bowel program, or is not getting better with this program, you should contact your primary
care clinician to tailor a program for your child’s specific needs. For more detailed information on medication, contact your
primary care clinician. No medication, or clean out, should be initiated without consulting the child's physician first.

Are there diet choices that can help my child's constipation?

Liquid – Inadequate liquid intake may contribute to constipation. Increasing water may be helpful, but can be difficult to
do, particularly with a young child. Avoid using sweetened beverages, especially sodas, to increase fluid intake. 1- 4 oz.
per day of prune or apple juice can help with constipation in some children and infants.

Fiber – Increasing fiber in the diet may reduce constipation. The best sources of fiber include whole grains, fruits, and
vegetables. Avoid highly processed and carbohydrate-rich foods that lack fiber as these may decrease appetite. If using formula,
consider switching to one with fiber.

Stimulating foods – Some foods may stimulate the intestines to move more quickly. Prunes are the most common of these, but
children may vary in which foods work best for them.

Constipating foods – Many foods seem to contribute to constipation, at least in some children. Bananas and cheese are the
most common. Again, this can vary among children.

Are ther other habits than can help my child's constipation?

Meals – Regular meals are helpful in keeping the bowels moving. Sitting on the toilet following meals can enhance the ease
of passing bowel movements.

Fewer snacks – Snacking, particularly “grazing” (eating small amounts of food, usually low in fiber, through the day), can
limit the amount of food eaten at meal times and result in a poor gastro-colic reflex, resulting in poor gut motility and
constipation.

Exercise – Kids who get plenty of exercise seem less likely to get constipated. Daily exercise also has benefits in terms
of fitness and weight control. Time in a stander or walker may help with evacuation for kids who spend most of their time
in a wheelchair or lying down.

Behavioral issues – For children who are toilet trained, ensure adequate time and privacy for defecation (e.g., it isn't going
to happen in a public school bathroom stall). During potty training, positively reinforce all passage of stool, and treat
accidents with a neutral approach.

Toileting routine – It is helpful if your child goes to the toilet and tries to poop after meals. This is particularly important
after breakfast on school days, when he or she may not have another opportunity to poop until evening. (See Toilet Training for CYSHCN.)

Positioning – Ensure the child is adequately supported in an upright position to allow optimal defecation. Placing the feet
on stool can help for kids whose feet don’t reach the ground. If indicated, obtain an adapted toilet seat with adequate support.
(Example: Squatty Potty).

Is there help with diaper costs?

Diapers are a huge health care expense. Generally Medicaid will cover the cost of diapers for the incontinent child after
age 3 through a home care company with a clinician’s prescription and letter of medical necessity. Less frequently, private
payers can be convinced to do this.

Dietary Fiber (IFFGD)Information about different kinds of fiber, how to incorporate fiber into the diet gradually, and serving sizes to help prevent
constipation; International Foundation for Functional Gastrointestinal Disorders.

Constipation (NASPGHAN) ( 178 KB)Fact Sheet about constipation with information about the diagnosis and management from the American Society for Pediatric
Gastroenterology, Hepatology and Nutrition (NASPGHAN).

Constipation (NASPGHAN) Spanish ( 177 KB)Fact Sheet in Spanish about constipation with information about the diagnosis and management from the American Society for
Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN).